Orthopaedic surgical instrument system for implanting a prosthetic patella component and method of use

ABSTRACT

An orthopaedic surgical instrument system includes a compression socket configured for coupling with a selected one of a number of compressible bases. Each compressible base is shaped to conform with a posterior surface of either a dome patella implant component or an anatomical patella implant component.

This is a divisional application and claims priority under 35 U.S.C. §121 to U.S. patent application Ser. No. 15/081,200, now U.S. Pat. No.10,278,714, which was filed on Mar. 25, 2016, and which claims priorityunder 35 U.S.C. § 119 to U.S. Provisional Patent App. No. 62/139,532,which was filed on Mar. 27, 2015, each of which is expresslyincorporated herein by reference.

CROSS REFERENCE

Cross reference is made to each of U.S. patent application Ser. No.13/630,935, now U.S. Pat. No. 9,855,065, entitled “ORTHOPAEDIC SURGICALINSTRUMENT SYSTEM FOR IMPLANTING A PROSTHETIC PATELLA COMPONENT” byJennifer B. Clever et al.; U.S. patent application Ser. No. 13/630,951,now U.S. Pat. No. 9,554,813, entitled “PATELLA DRILL GUIDE AND TRIALSURGICAL INSTRUMENT” by Jennifer B. Clever et al.; and U.S. patentapplication Ser. No. 13/630,965, now U.S. Pat. No. 9,700,330, entitled“METHOD FOR SURGICALLY IMPLANTING A PROSTHETIC PATELLA COMPONENT” byJennifer B. Clever et al. Each of these applications is assigned to thesame assignee as the present application, and is hereby incorporated byreference.

TECHNICAL FIELD

The present disclosure relates generally to orthopaedic surgicalinstruments and, more particularly, to patella surgical instruments.

BACKGROUND

Joint arthroplasty is a well-known surgical procedure by which adiseased and/or damaged natural joint is replaced by a prosthetic joint.A typical knee prosthesis includes a tibial tray, a femoral component,and a polymer insert or bearing positioned between the tibial tray andthe femoral component. In some cases, the knee prosthesis may alsoinclude a prosthetic patella component, which is secured to a posteriorside of the patient's surgically-prepared patella.

SUMMARY

According to one aspect, an orthopaedic surgical instrument systemincludes a clamp having a first lever pivotally coupled to a secondlever. A proximal end of the first lever includes an upper handle and adistal end of the first lever includes a retaining socket securedthereto. A proximal end of the second lever includes a lower handle anda distal end of the second lever includes a connector. The orthopaedicsurgical instrument system also includes a patella drill guide and trialinstrument having a connector configured to be selectively secured tothe connector of the clamp. The patella drill guide and trial instrumentalso includes a posterior trial bearing surface configured to articulatewith a condylar surface of a prosthetic femoral component. The patelladrill guide and trial instrument also includes an anterior surfaceopposite the posterior trial bearing surface and having a number ofspikes extending outwardly therefrom. The patella drill guide and trialinstrument also includes a number of drill guide holes extending fromthe posterior trial bearing surface to the anterior surface. Theorthopaedic surgical instrument system also includes a compressionsocket having connector configured to be selectively secured to theconnector of the clamp in place of the patella drill guide and trialinstrument. The compression socket has a receptacle defined in ananterior surface. The orthopaedic surgical instrument system alsoincludes a number of compressible bases configured to be selectivelyreceived in the receptacle of the compression socket. Each compressiblebase includes an anterior surface having a different shape from everyother compressible base. Each compressible base is formed from adeformable material such as, for example, a compression material.

In some embodiments, the number of compressible bases include a firstcompressible base. The anterior surface of the first compressible baseincludes a circular rim and a concavely curved surface extendinginwardly from the circular rim.

In some embodiments, the circular rim of the first compressible base hasa medial width and a lateral width that is greater than the medialwidth.

In some embodiments, the first compressible base has a medial thicknessand a lateral thickness that is greater than the medial thickness.

In some embodiments, the circular rim of the first compressible baseincludes a lateral section that defines a first imaginary plane and amedial section that defines a second imaginary plane, and a non-zeroangle is defined between the first imaginary plane and the secondimaginary plane.

In some embodiments, the number of compressible bases include a secondcompressible base that includes a body, a medial wedge extendinganteriorly from the body, and a lateral wedge extending anteriorly fromthe body. The medial wedge and the lateral wedge cooperate to define theanterior surface of the second compressible base.

In some embodiments, the medial wedge is connected to the lateral wedgeto define an oblong shape.

In some embodiments, the medial wedge includes a concavely curvedanterior surface that defines a portion of the anterior surface of thesecond compressible base.

In some embodiments, the lateral wedge includes a convexly curvedanterior surface that defines a second portion of the anterior surfaceof the second compressible base.

In some embodiments, the medial wedge has a maximum thickness, and thelateral wedge has a maximum thickness greater than the maximum thicknessof the medial wedge.

In some embodiments, the compression socket includes an annular flangeconfigured to selectively engage and retain each compressible base inthe receptacle.

In some embodiments, each compressible base includes aposteriorly-extending tab to orient the compressible base in thereceptacle of the compression socket.

In some embodiments, the compression socket comprises a ring having thereceptacle and a connecting slot formed therein. The connector of theclamp includes a connecting tongue configured to be received into theconnecting slot of the compression socket so as to secure thecompression socket to the clamp.

According to another aspect, an orthopaedic surgical instrument systemincludes a clamp having a first lever pivotally coupled to a secondlever. A proximal end of the first lever includes an upper handle and adistal end of the first lever includes a retaining socket securedthereto. A proximal end of the second lever includes a lower handle anda distal end of the second lever includes a connector. The orthopaedicsurgical instrument system also includes a patella drill guide and trialinstrument having a connector configured to be selectively secured tothe connector of the clamp. The patella drill guide and trial instrumentalso includes a posterior trial bearing surface configured to articulatewith a condylar surface of a prosthetic femoral component. The patelladrill guide and trial instrument also includes an anterior surfaceopposite the posterior trial bearing surface and having a number ofspikes extending outwardly therefrom. The patella drill guide and trialinstrument also includes a number of drill guide holes extending fromthe posterior trial bearing surface to the anterior surface. Theorthopaedic surgical instrument system also includes a compressionsocket having connector configured to be selectively secured to theconnector of the clamp in place of the patella drill guide and trialinstrument. The compression socket has a receptacle defined in ananterior surface. The orthopaedic surgical instrument system alsoincludes a compressible base, selected from a number of compressiblebases, configured to be selectively received in the receptacle of thecompression socket. The second lever includes a plurality of teeth. Thefirst lever includes a pawl having one end pivotably coupled to thefirst lever. The pawl is configured for slidable engagement with aspring-loaded member of a button such that positioning the button in afirst position engages the pawl with the pawl teeth, and sliding thebutton in a second position disengages the pawl with the teeth.

In some embodiments, the pawl includes a lower surface from whichextends a number of pawl teeth for selective engagement with the teethof the second lever, the pawl teeth being position on another end of thepawl.

In some embodiments, the pawl includes a pawl release extending from theanother end of the pawl for manually releasing the pawl in the event ofjamming.

In some embodiments, the pawl release is configured to receive an upwardforce on a lower surface thereof for manually pivoting the pawl suchthat the pawl teeth disengage the teeth of the second lever.

According to one aspect, a method of performing an orthopaedic surgicalprocedure on a patella of a patient, includes resecting the patella ofthe patient to produce a generally planar resected patellar surface,positioning a patella drill guide and trial instrument on the resectedpatellar surface. The patella drill guide and trial instrument having aposterior trial bearing surface configured to articulate with a condylarsurface of a prosthetic femoral component, and a number of drill guideholes formed in the posterior trial bearing surface. The number of drillguide holes extends through the patella drill guide and trialinstrument. The method further includes trialing the patellofemoraljoint with the patella drill guide and trial instrument positioned onthe resected patellar surface. The method further includes advancing adrill through the number of drill guide holes formed in the posteriortrial bearing surface of the patella drill guide and trial instrumentand into the resected patellar surface so as to drill a number of anchorholes in the patella of the patient subsequent to trialing thepatellofemoral joint. The method further includes selecting a patellacomponent from a group consisting of a dome patella component and ananatomic patella component. The method further includes selecting acompressible base from a number of compressible bases havingdifferently-shaped anterior surfaces from each other, an anteriorsurface of the selected compressible base being shaped to correspond tothe selected patella component. The method further includes securing theselected compressible base to a compression socket, securing thecompression socket to a removable clamp, positioning the selectedcompression socket into contact with the selected patella component, andoperating the removable clamp to clamp the patella component to thepatella of the patient.

In some embodiments, the method further includes securing the removableclamp to the patella drill guide and trial instrument subsequent totrialing the patellofemoral joint, but prior to advancing the drillthrough the number of drill guide holes formed in the posterior trialbearing surface of the patella drill guide and trial instrument to drillthe number of anchor holes in the patella of the patient.

BRIEF DESCRIPTION OF THE DRAWINGS

The detailed description particularly refers to the following figures,in which:

FIG. 1 is a perspective view of an orthopaedic surgical instrumentsystem showing the clamp, the patella drill guide and trial instrument,and the compressible bases, in exploded arrangement;

FIG. 2 is side elevation view of the system of FIG. 1;

FIG. 3 is a perspective view of the patella drill guide and trialinstrument of FIG. 1;

FIG. 4 is a plan view of the patella drill guide and trial instrument ofFIG. 1;

FIG. 5 is an exploded perspective view of the compression socket andcompressible bases;

FIG. 6 is a bottom perspective view of the compression socket;

FIG. 7 is a bottom plan view of the compression socket;

FIG. 8 is a bottom perspective view of the first compressible base ofthe system of FIG. 1;

FIG. 9 is an elevation view of the first compressible base of the systemof FIG. 1;

FIG. 10 is a bottom view of the first compressible base of the system ofFIG. 1;

FIG. 11 is a bottom perspective view of the second compressible base ofthe system of FIG. 1;

FIG. 12 is an elevation view of the second compressible base of thesystem of FIG. 1;

FIG. 13 is a bottom view of the second compressible base of the systemof FIG. 1;

FIG. 14 is a perspective view of the connector of the clamp;

FIG. 15 is a plan view of the clamp attached to the patella drill guideand trial instrument;

FIG. 16 a perspective view of the trial handle;

FIG. 17 is a perspective view of the trial handle inserted into thepatella drill guide and trial instrument of FIG. 1;

FIG. 18 is a perspective view of a dome patella implant and ananatomical patella implant;

FIG. 19 is an anterior view of the knee of a patient during trialing;

FIG. 20 is an elevation view of the system of FIG. 1 during drilling;

FIG. 21 is an elevation view of the system of FIG. 1 during clamping ofthe dome patella implant of FIG. 18; and

FIGS. 22-31 are additional illustrations of the system of FIG. 1.

DETAILED DESCRIPTION OF THE DRAWINGS

While the concepts of the present disclosure are susceptible to variousmodifications and alternative forms, specific exemplary embodimentsthereof have been shown by way of example in the drawings and willherein be described in detail. It should be understood, however, thatthere is no intent to limit the concepts of the present disclosure tothe particular forms disclosed, but on the contrary, the intention is tocover all modifications, equivalents, and alternatives falling withinthe spirit and scope of the invention as defined by the appended claims.

Terms representing anatomical references, such as anterior, posterior,medial, lateral, superior, inferior, etcetera, may be used throughoutthe specification in reference to the orthopaedic implants and surgicalinstruments described herein as well as in reference to the patient'snatural anatomy. Such terms have well-understood meanings in both thestudy of anatomy and the field of orthopaedics. Use of such anatomicalreference terms in the written description and claims is intended to beconsistent with their well-understood meanings unless noted otherwise.

Referring to FIG. 1, an orthopaedic surgical instrument system 10includes a removable patella clamp 12, a patella drill guide and trialinstrument 14 configured to be secured to the patella clamp 12, and acompression socket 16 configured to be secured to the patella clamp 12in place of the trial instrument 14. As described in greater detailbelow, the instrument system 10 is utilized to surgically prepare apatient's patella 300 for implantation of a prosthetic patella component302 (see FIGS. 18 and 21). To do so, the patella drill guide and trialinstrument 14 may be used as both a trial instrument to trial thepatellofemoral joint and as a drill guide to drill anchor holes into theplanar, resected posterior surface of the patient's patella 300. Thesurgeon may also use the patella drill guide and trial instrument 14 tosize and select a patella prosthetic component suitable for use with theparticular patient's patella. The surgeon may then attach thecompression socket 16 to the patella clamp 12 with one of thecompressible bases 18 corresponding to the selected patella prostheticcomponent to secure the prosthetic component to the patient's patella.

As shown in FIG. 1, the patella clamp 12 of the instrument system 10includes a pair of levers 20, 22 pivoted together with a pivot pin 24.The proximal end of the lever 20 includes an upper handle 26, with thedistal end of the lever 20 having a retaining socket 28. The proximalend of the lever 22 includes a lower handle 30, with the distal end ofthe lever 22 having a connector 32. The lever 22 is modular in design inthat the connector 32 is not integrally formed with the lower handle 30.A proximal end 34 of the connector 32 is captured in a slot 36 formed ina cylinder housing 38. As shown in FIG. 2, the proximal end 34 of theconnector 32 is coupled to the distal end 40 of the lower handle 30within the cylinder housing 38 such that the connector 32 is maintainedin substantially parallel relationship with the distal end 42 of thelever 20 as it translates upwardly and downwardly within the cylinderhousing 38. A compression spring 44 is positioned in the cylinderhousing 38 and exerts a spring bias on the proximal end 34 of theconnector 32 so as to urge the connector 32 in a direction away from theretaining socket 28.

When a surgeon squeezes or otherwise urges the two handles 26, 30 towardone another, the levers 20, 22 pivot about the pin 24 thereby causingthe connector 32 and the retaining socket 28 to move toward one another.When the surgeon releases the two handles 26, 30, the spring bias of thecompression spring 44 urges the connector 32 away from the retainingsocket 28 thereby causing the levers 20, 22 to pivot about the pin 24 soas to move the two handles 26, 30 away from one another.

As can be seen in FIG. 2, the lever 22 has a number of ratchet teeth 46formed therein. A button 48 is secured to the lever 20 near its upperhandle 26. The button 48 engages a locking pawl 50 such that the lockingpawl 50 is moved into engagement with the ratchet teeth 46 by slidingthe button 48 in a direction toward the cylinder housing 38, anddisengaged from the ratchet teeth 46 by sliding it in the oppositedirection. When the locking pawl 50 engages ratchet teeth 46, the levers20, 22 of the patella clamp 12 are locked and therefore prevented frommoving relative to one another. When the locking pawl 50 is disengagedfrom the ratchet teeth 46, the levers 20, 22 of the patella clamp 12 arefree to move relative to one another.

In the illustrative embodiment, the locking pawl 50 includes a flange 52that extends outwardly from lever 20. The flange 52 is sized such that asurgeon or other user may pull on the flange 52 in the directionindicated by arrow 54 to manually release the locking pawl 50 in theevent of, for example, jamming, which may occur when too much pressureis applied.

As can be seen in FIG. 1, in the illustrative embodiment describedherein, the clamp's retaining socket 28 is embodied as a ring 58 havinga number of spikes 60 extending outwardly therefrom. The spikes 60 facetoward a number of spikes of the patella drill guide and trialinstrument 14 when the instrument 14 is secured to the clamp 12. In suchan arrangement the clamp's spikes 60 cooperate with the spikes of thepatella drill guide and trial instrument 14 to capture the patella 300therebetween.

The patella clamp 12 may be constructed from a medical-grade metal suchas stainless steel, cobalt chrome, or titanium, although other metals oralloys may be used.

Referring now to FIGS. 3-4, the patella drill guide and trial instrument14 is shown in greater detail. As alluded to above, the patella drillguide and trial instrument 14 is used for fit assessment during asurgical procedure to implant the prosthetic patella component 302 intoa patient's surgically-prepared patella 300. In essence, the patelladrill guide and trial instrument 14 is used to ensure proper sizeselection of the ultimate patella component 302 (i.e., the patellacomponent 302 that is ultimately implanted in the patient's patella300). As will be discussed below in greater detail, the patella drillguide and trial instrument 14 also functions as a drill guide forguiding a drill bit used to drill the anchor holes in the patient'ssurgically-prepared patella 300 to receive the anchor pegs of thepatella component 302.

As shown in FIG. 3, the patella drill guide and trial instrument 14includes a posterior trial bearing surface 62 in the form of a curvedpeak surface configured to articulate with the condylar surface of the aprosthetic femoral component 304 (see FIG. 19). In particular, theposterior trial bearing surface 62 of the patella drill guide and trialinstrument 14 includes a lateral trial articular surface 64 and a medialtrial articular surface 66. The trial articular surfaces 64, 66 areconfigured to articulate with a lateral condyle surface 306 and a medialcondyle surface 308, respectively, of the femoral component 304. Thefemoral component 304 is configured to emulate the configuration of thepatient's natural femoral condyles, and, as such, the lateral condylesurface 306 and the medial condyle surface 308 are configured (e.g.,curved) in a manner which mimics the condyles of the natural femur. Thelateral condyle surface 306 and the medial condyle surface 308 arespaced apart from one another thereby defining a trochlear groove 310therebetween.

As can be seen in FIG. 4, the patella drill guide and trial instrument14 also includes a flat anterior surface 68 having a number of fixationmembers, such as spikes 70, extending anteriorly away therefrom. Thespikes 70 are configured to be inserted into a surgically preparedposterior surface of the patient's natural patella (not shown). In sucha way, the posterior trial bearing surface 62 of the patella drill guideand trial instrument 14 faces toward the femoral component 304 therebyallowing the posterior trial bearing surface 62 to articulate with thefemoral condyle surfaces 306, 308 during flexion and extension of thepatient's knee during a patellofemoral trialing procedure.

The patella drill guide and trial instrument's body has a number ofdrill guide holes 76 formed therein. The drill guide holes 76 extendthroughout the entire thickness of the patella drill guide and trialinstrument's body. That is, a posterior end 78 of the drill guide holes76 opens into the posterior trial bearing surface 62 of the patelladrill guide and trial instrument 14, with the opposite anterior end 80of the drill guide holes 76 opening into the instrument's anteriorsurface 66. The guide holes 76 function as drill guides for guiding adrill bit 84 (see FIG. 20) used to drill the anchor holes in thepatient's surgically-prepared patella 300 to receive the anchor pegs ofthe patella component 302. As such, the size and position of each of thedrill guide holes 76 coincides with the size and position of the anchorpegs (not shown) of the patella component 302.

As shown in FIGS. 3-4, the patella drill guide and trial instrument 14has an alignment bore 90 formed therein. Like the drill guide holes 76,the alignment bore 90 extends throughout the entire thickness of thepatella drill guide and trial instrument's body. That is, a posteriorend 92 of the alignment bore 90 opens into the posterior trial bearingsurface 62 of the patella drill guide and trial instrument 14, with theopposite anterior end 94 of the alignment bore 90 opening into a slot102 of the instrument's connector. In the illustrative embodiment, thealignment bore 90 functions as a visual alignment guide that allows thesurgeon to align the apex of the patella drill guide and trialinstrument 14 with the former location of the apex of the patient'snatural patella 300 prior to resection of the patella 300.

As alluded to above, the patella drill guide and trial instrument 14 maybe selectively secured to the removable patella clamp 12. In thatregard, the patella drill guide and trial instrument 14 includes afemale connector geometry configured to receive the male geometry of theconnector 32 of the patella clamp 12 (see FIG. 14). Specifically, thebody of the patella drill guide and trial instrument 14 has a connectingslot 102 formed therein. As shown in FIG. 4, the connecting slot 102 ispositioned between the posterior trial bearing surface 62 and theanterior surface 68. The connecting slot 102 is shaped and sized toreceive a connecting tongue 104 of the patella clamp's connector 32. Asshown in FIG. 14, the connecting tongue 104 includes a tip 106 whichextends outwardly from a rounded surface of the main body of theconnector 32. As can be seen in FIG. 4, the connecting slot 102 of thepatella drill guide and trial instrument 14 has a similar shape,including a tip recess 108 that is sized and shaped to receive the tip106 of the patella clamp's connecting tongue 104.

As shown in FIG. 4, the upper sidewall 110 that defines the uppersurface of the connecting slot 102 has a locking recess 112 definedtherein. In the exemplary embodiment described herein, the lockingrecess 112 is generally oblong in shape. The locking recess 112 is sizedand positioned to receive a locking mechanism of the patella clamp'sconnector 32 to secure the patella clamp 12 to the patella drill guideand trial instrument 14. In an embodiment, the locking mechanism isembodied as a leaf-spring biased plunger 114 positioned on the tip 106of the patella clamp's connecting tongue 104. As the patella clamp'sconnector 32 is inserted in the connecting slot, the plunger 114 isurged downwardly against its spring bias by the upper sidewall 110 untilit reaches a position in which the plunger 114 is moved into the lockingrecess 112 by its spring bias. When the plunger 114 is positioned in thelocking recess 112, the patella clamp 12 is firmly secured to thepatella drill guide and trial instrument 14 until sufficient force isapplied to pull the two components apart by urging the plunger 114downwardly out of the locking recess 112 to allow the patella clamp 12to be separated from the patella drill guide and trial instrument 14.

In order to fit the needs of a given patient's anatomy, the patelladrill guide and trial instrument 14 may be provided in a number ofdifferent sizes. For example, in the illustrative embodiment describedherein, the patella drill guide and trial instrument 14 may be embodiedin five different medial/lateral lengths (e.g., 29 mm, 32 mm, 35 mm, 38mm, and 41 mm) so as to mimic the various sizes of the prostheticpatella components 302. It should also be appreciated that in otherembodiments the patella drill guide and trial instrument may be embodiedto mimic other types of patella components. For example, the patelladrill guide and trial instrument may be embodied to mimic “conforming”or “anatomic” patella components (see FIG. 18), which are designed toconform with the condylar surfaces of the femur.

In the exemplary embodiment described herein, the patella drill guideand trial instrument 14 is embodied as a monolithic metal bodyconstructed with a biocompatible metal that allows for smootharticulation between the patella drill guide and trial instrument 14 andthe femoral component 304. Examples of such biocompatible metals includestainless steel, cobalt chrome, or titanium, although other metals oralloys may be used. The patella drill guide and trial instrument 14 mayalso be embodied as a monolithic polymer trial instrument. As such, thepatella drill guide and trial instrument 14 may be made of any suitablemedical-grade polymeric material. Examples of such polymeric materialsinclude polyetheretherketone (PEEK), ultrahigh molecular weightpolyethylene (UHMWPE), or acetal. In such an embodiment, the monolithicpolymer trial may include metallic inserts (e.g., sleeves) positioned inthe drill guide holes 76.

Referring now to FIGS. 5-13, the removable clamp 12 may also be securedto a compression socket 16, which is configured to be selectivelycoupled to one of a number of compressible bases 18. The bases 18 andthe socket 16 may be used to assert clamping pressure on the patellacomponent 302 as it is cemented in place on the patient's resectedpatella 300. Each compressible base 18 is formed of a deformablematerial and functions to engage the posterior bearing surface 312 ofthe patella component 302. As described in greater detail below, thecompressible bases 18 include a dome patella base 120 shaped to engage adome-shaped patella prosthetic component 314 (see FIG. 18) and ananatomic base 122 shaped to engage an anatomic patella prostheticcomponent 316 (see FIG. 18).

As shown in FIG. 5, the compression socket 16 includes a body 124 thatis the form of a ring. The body 124 of the compression socket 16 may beembodied as a monolithic metal body constructed with a biocompatiblesuch as stainless steel, cobalt chrome, or titanium, although othermetals or alloys may be used. The body 124 may also be embodied as amonolithic polymer trial instrument constructed with any suitablemedical-grade polymeric material such as polyetheretherketone (PEEK),ultrahigh molecular weight polyethylene (UHMWPE), or acetal. Thecompressible bases 18 may be constructed with any suitable medical-gradecompressible material such as an elastomeric material. In theillustrative embodiment, each of the bases 18 is formed from silicone.

In order to fit the needs of a given patient's anatomy, the compressiblebases 18 and/or socket 16 may be provided in a number of differentsizes. For example, in the illustrative embodiment described herein, thecompressible bases 18 and/or socket 16 may be embodied in five differentmedial/lateral lengths (e.g., 29 mm, 32 mm, 35 mm, 38 mm, and 41 mm) soas to mimic the various sizes of the prosthetic patella components 302.

The compression socket 16 includes a female connector geometry that issimilar to that of the patella drill guide and trial instrument 14 and,as a result, configured to receive the male geometry of the connector 32of the patella clamp 12. Specifically, the body 124 of the compressionsocket 16 has a connecting slot 126 formed therein. As shown in FIGS.5-7, the connecting slot 126 is shaped and sized to receive theconnecting tongue 104 of the patella clamp's connector 32. The uppersidewall 130 that defines the upper surface of the connecting slot 126has a locking recess 132 defined therein. In the exemplary embodimentdescribed herein, the locking recess 132 is generally oblong in shape.The locking recess 112 is sized and positioned to receive the plunger114 of the patella clamp 12. As the patella clamp's connector 32 isinserted in the connecting slot 126, the plunger 114 is urged downwardlyagainst its spring bias by the upper sidewall 130 until it reaches aposition in which the plunger 114 is moved into the locking recess 132by its spring bias. When the plunger 114 is positioned in the lockingrecess 132, the patella clamp 12 is firmly secured to the compressionsocket 16 until sufficient force is applied to pull the two componentsapart by urging the plunger 114 downwardly out of the locking recess 112to allow the patella clamp 12 to be separated from the compressionsocket 16.

As shown in FIG. 6, the socket body 124 has an opening 134 defined inits anterior surface 136. The opening 134 is defined by an annularflange 138 that extends inwardly from an inner wall 140 of the socketbody 124. The inner wall 140 cooperates with an anterior wall 142 of thesocket body 124 to define a receptacle 144 that is sized to selectivelyreceive any of the bases 18. The receptacle 144 includes an orientationslot or groove 146 is defined in the anterior wall 142. In theillustrative embodiment, the groove 146 is defined by a number of shapedwalls 148 that correspond to the shape of the orientation tab 150 ofeach base 18. As described in greater detail, the groove 146 cooperateswith the tab 150 to ensure that each base 18 is attached to the socketbody 124 in its proper orientation.

As described above, the compressible bases 18 include a dome patellabase 120 shaped to engage a dome-shaped patella prosthetic component 314(see FIG. 18). In the illustrative embodiment, the dome patella base 120includes a ring-shaped body 152 that has an anterior surface 154positioned opposite a posterior surface 156. As shown in FIG. 9, theorientation tab 150 extends outwardly from the posterior surface 156.The body 152 includes a platform 158 having a cylindrical outer wall 160that extends posteriorly from the anterior surface 154. The body 152also includes a plug 162 extending from the posterior end 164 of theplatform 158. The plug 162 includes an outer flange 166 that isconfigured to engage the annular flange 138 of the socket body 124 toretain the base 120 in the socket 16. In the illustrative embodiment,the outer flange 166 includes a curved outer surface 168.

As shown in FIG. 8, the anterior surface 154 of the compressible base120 includes a rim 170 and a concavely curved surface 172 that extendsinwardly from the rim 170. The curved surface 172 is shaped to receivethe posterior surface 320 of the dome-shaped patella prostheticcomponent 314 (see FIG. 18). In the illustrative embodiment, the rim 170has a circular outer edge but it should be appreciated that in otherembodiments it may be oblong or oval.

The rim 170 includes a crescent-shaped surface 174 that defines thelateral section of the rim 170. As shown in FIG. 10, the crescent-shapedsurface 174 has a maximum width 176 defined along an imaginary line 178extending in a medial-lateral direction. The width 176 is the lateralwidth of the rim 170. The medial width 180 of the rim 170 is alsodefined along the imaginary line 178. In the illustrative embodiment,the lateral width 176 is greater than the medial width 180. In that way,the dome patella base 120 is medialized, i.e., the concavely curvedsurface 172 is shifted toward the medial side of the base 120.

As shown in FIG. 9, the crescent-shaped surface 174 is substantiallyplanar and defines an imaginary plane 182. The medial section 184 of therim 170 extends at an angle relative to the surface 174 and definesanother imaginary plane 186. In the illustrative embodiment, a non-zeroangle α is defined between the planes 182, 186. As a result, the medialthickness of the base 120 is less than the lateral thickness.

As described above, the compressible bases 18 include an anatomic base122 shaped to engage an anatomic patella prosthetic component 316 (seeFIG. 18). In the illustrative embodiment, the anatomic base 122 includesa ring-shaped body 188, as shown in FIGS. 11-12. The ring-shaped body188 includes a plug 190 having an outer flange 192 that is configured toengage the annular flange 138 of the socket body 124 to retain the base122 in the socket 16. In the illustrative embodiment, the outer flange192 includes a curved outer surface 194.

The plug 190 includes a posterior surface 196, and the orientation tab150 of the base 122 extends outwardly from the surface 196. The body 188also includes a platform 198 that extends anteriorly from the plug 190.The platform 198 includes the anterior surface 200 of the anatomic base122, which is shaped to engage an anatomic patella prosthetic component316.

In the illustrative embodiment, the platform 198 is saddle-shaped andincludes a connecting body 202, a lateral wedge 204 and a medial wedge206 that extend anteriorly from the connecting body 202. The wedges 204,206 cooperate to define the anterior surface 200 of the anatomic base122. As shown in FIG. 13, the wedges 204, 206 are connected and define aposterior edge 208 that is illustratively an oblong shape. Theconnecting body 198, on the other hand, illustratively includes acircular-shaped outer wall 210.

In the illustrative embodiment, the configuration of the lateral wedge204 is different from the configuration of the medial wedge 206. Asshown in FIGS. 11-13, the lateral wedge 204 includes a convexly curvedanterior surface 212 that defines one portion of the anterior surface200 of the anatomic base 122. The medial wedge 206, on the other hand,includes a concavely curved surface 214 that defines another portion ofthe anterior surface 200 of the base 122. The shapes of the surfaces212, 214 correspond to the shape of the posterior surface 320 of theanatomic patella prosthetic component 316, as described in greaterdetail below.

Returning to FIG. 12, the lateral wedge 204 extends to an anterior tip216, and a maximum thickness 218 is defined between the tip 216 and theposterior edge 208 of the wedges 204, 206. Similarly, the medial wedge206 extends to an anterior tip 220, and a maximum thickness 222 isdefined between the tip 220 and the posterior edge 208 of the wedges204, 206. As shown in FIG. 12, the thickness 218 is greater than thethickness 222.

As shown in FIGS. 16 and 17, the patella drill guide and trialinstrument 14 may also be secured to an alignment handle 230. Use of thealignment handle 230 allows the surgeon to assess the rotationalalignment of the patella drill guide and trial instrument 14 as itarticulates in the trochlear groove 310 of the femoral component 304during trialing of the patellofemoral joint. The alignment handle 230includes a relatively flat elongated flange 232 having a connector 234formed in one end thereof. The connector 234 of the alignment handle isidentical to the patella clamp's connector 32 so as to mate with theconnector of the patella drill guide and trial instrument 14 in anidentical manner as the patella clamp 12. As such, the alignmenthandle's connector 234 has a connecting tongue 236 that includes a tip238 which extends outwardly from a rounded surface of the main body ofthe connector 234. The connecting tongue 236 and its tip 238 arereceived into the connecting slot 102 of the patella drill guide andtrial instrument 14 in a similar manner as the similar structures of thepatella clamp's connector 32.

Likewise, the alignment handle's connector 234 includes a lockingmechanism to secure the alignment handle 230 to the patella drill guideand trial instrument 14. In an embodiment, the locking mechanism isembodied as a biased plunger positioned on the tip 238 of the alignmenthandle's connector 234. In a specific embodiment, the biased plunger maybe embodied as a leaf spring-biased plunger 240. The plunger 240 may becaptured in the locking recess 112 of the connecting slot 102 of thepatella drill guide and trial instrument 14 to firmly secure thealignment handle 230 to the patella drill guide and trial instrument 14in an identical manner to as described above in regard to attachment ofthe patella clamp 12. The alignment handle 230 remains secured to thepatella drill guide and trial instrument 14 by the plunger 240 untilsufficient force is applied to pull the two components apart by urgingthe plunger 240 downwardly out of the locking recess 112 to allow thealignment handle 230 to be separated from the patella drill guide andtrial instrument 14.

Referring now to FIG. 18, a pair of prosthetic patella components 302 ofan implantable knee prosthesis are shown. The components 302 include adome-shaped patella component 314 and an anatomic patella component 316.Both of the patella components 314, 316 include a posterior bearingsurface 320 configured to articulate with the condylar surfaces of thefemoral component 304. In particular, the posterior bearing surface 320of the patella components 314, 316 includes a lateral articular surface322 and a medial articular surface 324. The articular surfaces 322, 324are configured to articulate with a lateral condyle surface 306 and amedial condyle surface 308, respectively, of the femoral component 304.Each of the components 314, 316 have a number of fixation members, suchas pegs (not shown), extending away their respective anterior surfaces.The pegs are configured to be implanted into a surgically preparedposterior surface of the patient's natural patella (not shown). Asdescribed above, the instrument 14 may be used to drill holes in thepatient's patella 300 sized and positioned to receive the pegs.

As shown in FIG. 18, the posterior surface 320 of the dome-shapedpatella prosthetic component 314 is generally convex in shape andincludes a curved peak surface 326 that defines the posterior-most point328 of the component 314. In the illustrative embodiment, the point 328is medialized. In that way, the lateral articular surface 322 is largerthan the medial articular surface 324. The posterior surface 320 of theanatomic patella prosthetic component 316 also includes a curved peaksurface 330 that defines the posterior-most point 332 of the component316. In the illustrative embodiment, the point 332 is also medializedsuch that the lateral articular surface 322 is larger than the medialarticular surface 324. Additionally, as shown in FIG. 18, the lateralarticular surface 322 of the anatomic patella prosthetic component 316includes a concave section 334 and the medial articular surface 324includes a convex section 336.

Each of the patella components 314, 316 is embodied as a monolithicpolymer body constructed with a material that allows for smootharticulation between the patella components 314, 316 and the femoralcomponent 304. One such polymeric material is polyethylene such asultrahigh molecular weight polyethylene (UHMWPE).

Referring now to FIGS. 19-21, there is shown a surgical procedure inwhich the various instruments described herein in regard to FIGS. 1-17are used to surgically prepare the patient's patella 300 forimplantation of one of the prosthetic patella components 302 of FIG. 18.The surgical procedure begins with preoperative planning in which,amongst other things, a CT scan or other type of preoperative image maybe obtained to plan the placement location and orientation of thepatella component 302. With the preoperative planning complete, thepatient's soft tissue is dissected and retracted in order to allowaccess to the knee. Full exposure of the patient's joint is typicallyachieved so as to expose, in addition to the patella 300, the patient'sfemur 350 and tibia 352.

In addition to implantation of one of the patella components 302, thesurgical procedure also replaces the patient's natural distal femur 350with a prosthetic femoral component 304 and the patient's naturalproximal tibia 352 with a tibial tray 356 and tibial bearing 358.However, the surgical implantation of the femoral component 304, thetibial tray 356, and tibial bearing 358 is not described in detailherein. Moreover, although the patella 300 is shown in its anatomicalposition relative to the femur 350 and the tibia 352 in FIG. 19, thepatella 300 is shown in isolation from its anatomical position in theremaining figures for clarity of description.

To prepare the posterior surface of the patient's patella, the surgeonmay then resect the patient's natural patella 300. Specifically, thesurgeon may use a resection guide (not shown) and a bone saw (also notshown) to produce a generally planar surgically-resected patellarsurface 370 onto which the patella component 302 will be subsequentlyimplanted. Although numerous different instruments and methods may beused to resect the patient's natural patella 300, illustrativeinstruments and methods for doing so are described in commonly-owned,U.S. Pat. No. 8,986,306, which is entitled “Patella Orthopaedic SurgicalMethod.”

The surgeon may then select an appropriately-sized patella drill guideand trial instrument 14. Once the patella drill guide and trialinstrument 14 of the proper size has been selected, the surgeon maysecure the patella drill guide and trial instrument 14 to thesurgically-resected patellar surface 370. To do so, the surgeonpositions the patella drill guide and trial instrument 14 in a desiredlocation and orientation for the final implant (i.e., the patellacomponent 302) by aligning the alignment bore 90 of the selected patelladrill guide and trial instrument 14 with a drilled alignment hole (notshown). So positioned, the spikes 70 of the patella drill guide andtrial instrument 14 face downwardly toward the surgically-resectedpatellar surface 370, and the patella drill guide and trial instrument14 may be pressed into the surgically-resected patellar surface 370.

It should be appreciated that the surgeon may press the patella drillguide and trial instrument 14 into the bone tissue of thesurgically-resected patellar surface 370 by hand with the application offinger pressure alone. However, in certain cases, it may be necessary toutilize additional force in order to fully seat the patella drill guideand trial instrument 14 in the surgically-resected patellar surface 370.In such cases, the surgeon may install the removable clamp 12 to thepatella drill guide and trial instrument 14 and use the clamp 12 toapply a clamping force which urges the instrument's spikes 60 into thebone tissue of the surgically-resected patellar surface 370 so as tofully seat the patella drill guide and trial instrument 14.

Once the patella drill guide and trial instrument 14 has been installedon the surgically-resected patellar surface 370, the surgeon may thenperform a trial of the patellofemoral joint to assess size andpositioning. To do so, the surgeon first installs the alignment handle230 to the patella drill guide and trial instrument 14. Use of thealignment handle 230 allows the surgeon to assess the rotationalalignment of the patella drill guide and trial instrument 14 as itarticulates in the trochlear groove of the femoral component 304 duringtrialing of the patellofemoral joint. To secure the alignment handle 230to the patella drill guide and trial instrument 14, the surgeon insertsthe handle's connector 234 into the connecting slot 102 of the patelladrill guide and trial instrument 14. In doing so, the handle's plunger240 is captured in the locking recess 112 of the connecting slot 102 ofthe patella drill guide and trial instrument 14 to firmly secure thealignment handle 140 to the patella drill guide and trial instrument 14.

Once the alignment handle 230 is installed, the surgeon may thenposition the patella drill guide and trial instrument 14 such that itsposterior trial bearing surface 62 is positioned to articulate withinthe trochlear groove 310 of the femoral condyle surfaces 306, 308 of thefemoral component 304, as shown in FIG. 19. The surgeon may thenmanipulate the patient's leg so as to perform a trial articulation ofthe patellofemoral joint. In doing so, the surgeon may use the alignmenthandle 230 as a visual indicator of the rotational alignment of thepatella drill guide and trial instrument 14 as it articulates in thetrochlear groove 310 of the femoral component 304. Specifically, asshown in FIG. 19, if the medial edge of the patella drill guide andtrial instrument 14 (i.e., the edge into which the connecting slot 102is formed) is properly aligned, the alignment handle 230 extendsoutwardly in a direction generally perpendicular to the long axis of thefemur and tibia. That is, it extends outwardly generally in themedial/lateral direction.

Based on the above, the surgeon may assess the rotational position andalignment of the patella drill guide and trial instrument 14 throughouta trial articulation of the patellofemoral joint by monitoring theposition of the alignment handle 230. If at any time during the trialingprocedure the alignment handle 230 does not maintain the desired anglerelative to the long axis of the femur and tibia (i.e., it does notextend generally in the medial/lateral direction), the surgeon mayperform a corrective procedure on the positioning of the patella drillguide and trial instrument 14 to improve the rotational positioningthereof.

Once the surgeon has completed the trial articulation of thepatellofemoral joint and made any necessary adjustments to the positionof the patella drill guide and trial instrument 14, the surgeon may thendrill a number of anchor holes 380 in the surgically-resected patellarsurface 370. The anchor holes 380 are sized and positioned to receivethe anchor pegs of the selected patella component 302. To do so, thesurgeon first secures the removable clamp 12 to the patella drill guideand trial instrument 14 by advancing the clamp's connector 32 into theconnecting slot 102 of the patella drill guide and trial instrument 14.In doing so, the handle's plunger 114 is captured in the locking recess112 of the connecting slot 102 of the patella drill guide and trialinstrument 14 to firmly secure the patella clamp 12 to the patella drillguide and trial instrument 14.

The surgeon then squeezes the clamp's handles 26, 30 toward one another,thereby moving the patella drill guide and trial instrument 14 and theretaining socket 28 toward one another so as to clamp the patella 300therebetween. With the patella 300 secured by the clamp 12, the surgeonmay now drill the anchor holes 380. To do so, the surgeon may advancethe rotating tip of the surgical drill's bit 84 into the opening formedin the posterior trial bearing surface 62 of one of the drill guideholes 76 and through the patella drill guide and trial instrument 14 sothat it exits the guide hole 76 through the instrument's anteriorsurface 68 and enters the bone tissue of the surgically-resectedpatellar surface 370. The surgeon may then drill the remaining anchorholes 180 in a similar manner.

As noted above, the size and position of each of the drill guide holes76 coincides with the size and position of the anchor pegs of thepatella component 302. As such, once the surgeon has advanced thedrill's surgical bit 84 through each of the guide holes 76, thesurgically-resected patellar surface 370 is prepared for implantation ofone of the patella components 302.

Referring now to FIG. 21, once the anchor holes 380 have been drilled inthe surgically-resected patellar surface 370, the surgeon may select anappropriately sized patella component 314 or an appropriately sizedpatella component 316 for implantation. If the surgeon selects adome-shaped patella component 314, the surgeon may apply bone cement tothe anterior surface of the patella component 314. The patella component314 is then positioned over the surgically-resected patellar surface 370such that the component's anchor pegs are aligned with their respectiveanchor holes 380. Thereafter, the patella component 314 may be advancedsuch that the anchor pegs are received into the anchor holes 380 and theanterior surface is positioned in contact with the surgically-resectedpatellar surface 370.

The surgeon may then select the compressible base 18 corresponding tothe selected component 302. If the component 314 is selected, thesurgeon selects the dome patella base 120 and attaches the base 120 tothe socket body 124. To do so, the surgeon aligns the orientation tab150 of the base 120 with the orientation groove 146 of the socket body124. The surgeon may then advance the base 120 into the body 124 suchthat the plug 162 is advanced into the receptacle 144 defined in thesocket body 124. The plug 162 may deform slightly as it enters thereceptacle before the outer flange 166 engages the annular flange 138 ofthe socket body 124, thereby securing the dome patella base 120 to thesocket body 124.

The removable clamp 12 may then be secured to the compression socket 16and base 120 by inserting the clamp's connector 32 into the socket'sconnecting slot 126. The compression socket 16 may then be used toassert clamping pressure on the patella component 302 as it is cementedin place on the patient's resected patella 300. That is, the compressionsocket 16 and clamp 12 may be used to maintain clamping pressure on thepatella component 302 as the bone cement polymerizes. To do so, the base120 of the compression socket 16 is positioned over the posteriorbearing surface 320 of the patella component 314. The surgeon thensqueezes the clamp's handles 26, 30 toward one another, thereby movingthe compression socket 16 and the retaining socket 28 toward oneanother. During such movement, the base 120 of the compression socket 16is advanced into contact with the posterior bearing surface 320 of thepatella component 314. The patella component 314 is seated within andstabilized by a concave surface 172 of the compressible base 120 suchthat the patella component 314 is clamped firmly to the resected patella300 until polymerization is complete and the patella component 314 issecured thereto. The surgeon may slide the patella clamp's button 48forward to lock the clamp 12 in its current position during thepolymerization process.

As described above, the button 48 of the clamp 12 engages a locking pawl50 such that the locking pawl 50 is disengaged from the ratchet teeth 46by sliding the button 48 in the opposite direction. When the lockingpawl 50 is disengaged from the ratchet teeth 46, the levers 20, 22 ofthe patella clamp 12 are free to move relative to one another andrelease the instrument 14 from the patella 300. In the event of jamming,the surgeon may pull on the flange 52 in the direction indicated byarrow 54 to manually release the locking pawl 50 and free the levers 20,22 of the patella clamp 12 to move relative to one another.

If the anatomic patella prosthetic component 316 is selected, thesurgeon may select the anatomic patella base 122 and attach the base 122to the socket body 124. To do so, the surgeon aligns the orientation tab150 of the base 122 with the orientation groove 146 of the socket body124. The surgeon may then advance the base 122 into the body 124 suchthat the plug 190 is advanced into the receptacle 144 defined in thesocket body 124. The plug 190 may deform slightly as it enters thereceptacle before the outer flange 192 engages the annular flange 138 ofthe socket body 124, thereby securing the anatomic patella base 122 tothe socket body 124.

The removable clamp 12 may then be secured to the compression socket 16and base 120 by inserting the clamp's connector 32 into the socket'sconnecting slot 126. The compression socket 16 may then be used toassert clamping pressure on the patella component 316 as it is cementedin place on the patient's resected patella 300. That is, the compressionsocket 16 and clamp 12 may be used to maintain clamping pressure on thepatella component 302 as the bone cement polymerizes. To do so, the base120 of the compression socket 16 is positioned over the posteriorbearing surface 320 of the patella component 314. In the illustrativeembodiment, the lateral wedge 204 is aligned with the concave section334 of the lateral articular surface 322 of the component 316, while themedial wedge 206 is aligned with the convex section 336 of the medialarticular surface 324 of the component 316.

The surgeon then squeezes the clamp's handles 26, 30 toward one another,thereby moving the compression socket 16 and the retaining socket 28toward one another. During such movement, the base 122 of thecompression socket 16 is advanced into contact with the posteriorbearing surface 320 of the patella component 316 such that the lateralwedge 204 is received in the concave section 334 of the lateralarticular surface 322 of the component 316, while with the convexsection 336 of the medial articular surface 324 of the component 316 isreceived in the medial wedge 206 of the base 122. In that way, thepatella component 316 is stabilized by the wedges 204, 206 of thecompressible base 122 such that the patella component 316 is clampedfirmly to the resected patella 300 until polymerization is complete andthe patella component 314 is secured thereto. The surgeon may slide thepatella clamp's button 48 forward to lock the clamp 12 in its currentposition during the polymerization process.

While the disclosure has been illustrated and described in detail in thedrawings and foregoing description, such an illustration and descriptionis to be considered as exemplary and not restrictive in character, itbeing understood that only illustrative embodiments have been shown anddescribed and that all changes and modifications that come within thespirit of the disclosure are desired to be protected.

There are a plurality of advantages of the present disclosure arisingfrom the various features of the method, apparatus, and system describedherein. It will be noted that alternative embodiments of the method,apparatus, and system of the present disclosure may not include all ofthe features described yet still benefit from at least some of theadvantages of such features. Those of ordinary skill in the art mayreadily devise their own implementations of the method, apparatus, andsystem that incorporate one or more of the features of the presentinvention and fall within the spirit and scope of the present disclosureas defined by the appended claims.

The invention claimed is:
 1. A method of performing an orthopaedicsurgical procedure on a patella of a patient, comprising: resecting thepatella of the patient to produce a generally planar resected patellarsurface, positioning a patella drill guide and trial instrument on theresected patellar surface, the patella drill guide and trial instrumenthaving (i) a posterior trial bearing surface configured to articulatewith a condylar surface of a prosthetic femoral component and (ii) anumber of drill guide holes formed in the posterior trial bearingsurface and extending through the patella drill guide and trialinstrument, trialing the patellofemoral joint with the patella drillguide and trial instrument positioned on the resected patellar surface,advancing a drill through the number of drill guide holes formed in theposterior trial bearing surface of the patella drill guide and trialinstrument and into the resected patellar surface so as to drill anumber of anchor holes in the patella of the patient subsequent totrialing the patellofemoral joint, selecting a patella component from agroup consisting of a dome patella component and an anatomic patellacomponent, selecting a compressible base shaped to correspond to theselected patella component from a group consisting of dome compressiblebase having an anterior surface shaped to conform to a posterior surfaceof the dome patella component and an anatomic compressible base havingan anterior surface shaped to conform to a posterior surface of theanatomic patella component, securing the selected compressible base to acompression socket, securing the compression socket to a removableclamp, positioning the selected compression socket into contact with theselected patella component, and operating the removable clamp to clampthe patella component to the patella of the patient.
 2. The method ofclaim 1, further comprising securing the removable clamp to the patelladrill guide and trial instrument subsequent to trialing thepatellofemoral joint, but prior to advancing the drill through thenumber of drill guide holes formed in the posterior trial bearingsurface of the patella drill guide and trial instrument to drill thenumber of anchor holes in the patella of the patient.
 3. The method ofclaim 1, wherein the dome patella component includes a convex, curvedposterior surface and the anatomic patella includes a body, a medialpeak extending posteriorly from the body, and a lateral peak extendingposteriorly from the body, the medial peak and the lateral peakcooperating to define the posterior surface of the anatomic patellacomponent.
 4. The method of claim 1, wherein the dome compressible basehas a circular rim and a concavely curved surface extending inwardlyfrom the circular rim that is shaped to engage the posterior surface ofthe dome patella component.
 5. The method of claim 1, wherein theanatomic compressible base has a body, a medial wedge extendinganteriorly from the body, and a lateral wedge extending anteriorly fromthe body, the medial wedge and the lateral wedge cooperating to definethe anterior surface of the anatomic compressible base, the anteriorsurface of the anatomic compressible base being shaped to engage theposterior surface of the anatomic patella component.